Departamento de Psicologa

Expediente No.
ANAMNESIS INFANTIL
I.

Datos generales
Nombre del nio(a):________________________________________________________
Lugar y fecha de nacimiento: ________________________________________________
Edad: _________________aos __________________ mes(es)_______________ da(s)
Gnero: _____________________ Nacionalidad: ________________________________
Grado escolar: ____ Seccin: ___ Maestro(a) encargado(a): _______________________
Establecimiento Escolar: ____________________________________________________
Nombre de padre: _________________________________________________________
Edad: ________ Estado Civil: _______________ Religin: _________________________
Escolaridad: ________________________ Telfono(s):___________________________
Ocupacin: ______________________________________________________________
Nombre de la madre: ______________________________________________________
Edad: ________ Estado Civil: _______________ Religin: _________________________
Escolaridad: ________________________ Telfono(s):___________________________
Ocupacin: ______________________________________________________________
Nombre del encargado(a):___________________________________________________
Edad: ________ Estado Civil: _______________ Religin: _________________________
Escolaridad: ________________________ Telfono(s):___________________________
Ocupacin: ______________________________________________________________

II.

Motivo de consulta
Padre/Madre/Encargado
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Establecimiento Escolar: Direccin/Maestro(a)
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III.

Historia espontnea

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IV.
Historia del problema actual (cuando comenz a manifestarse y que acontecimientos se asocian)

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V.
Conducta habitual (comportamiento general del nio antes de presentar el problema)
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VI.

Historia personal

a. Historia prenatal
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Edad de los padres al embarazo
Madre: _______ Padre:______
Duracin del embarazo: _________ Embarazos anteriores: ________________________
Durante el embarazo hubo amenaza de aborto: ________________________________
Reaccin de los padres ante el embarazo (deseado, no deseado, planificado, accidente, etc)
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Hubo control prenatal? ____________ Mdico: _________ comadrona: _____________
Alimentacin de la madre durante el embarazo: _________________________________
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Us algn medicamento? SI NO Cul? _________________________________
Us drogas? SI NO Cul? ____________________________________________
Cigarrillos: SI NO
Bebidas alcohlicas: SI NO Frecuencia: _______________
Padeci alguna enfermedad durante el embarazo?______________________________
Hubo problemas emocionales? _____________________________________________
Actividad cotidiana durante el embarazo: _____________________________________
Observaciones

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b. Historia perinatal
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Lugar donde fue atendido el parto: ____________________________________________
Quin atendi el parto? ___________________________________________________
Cunto dur la labor? _________________________ Us frceps? SI NO
Hubo llanto inmediato? SI NO Naci amarillo? SI NO Peso al nacer: ________
Cunto midi? _____________________Posicin al nacer: _______________________
Observaciones (complicaciones, APGAR, diagnstico del mdico al nacer, contacto con la madre)
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c. Historia postnatal
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Tiempo que permaneci en el hospital: ________________________________________
Observaciones
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d. Alimentacin
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Lactancia
Materna
Mixta
Artificial
Duracin ________________
Caractersticas del destete: _________________________________________________
Us pepe? SI NO
Hubo succin de pulgar? SI NO otros: _______________
Responsable de la alimentacin: _____________________________________________
Edad que inici a ingerir alimentos slidos: _______ alimentos: _____________________
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Preferencias alimenticias: ___________________________________________________
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Aversiones alimenticias: ____________________________________________________
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Castigos por no comer:_____________________________________________________
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Reacciones anorxicas o bulmicas: ___________________________________________

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Caractersticas de la primera denticin: ________________________________________
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Observaciones
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e. Desarrollo motor
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A qu edad alcanz cada una de las siguientes habilidades motoras
Sostuvo la cabeza: ____________________ Gate: _____________________
Volte el cuerpo: _____________________ Se sent: ___________________
Camin: ____________________________ Salt: ______________________
Dibuj garabatos: ____________________ Corri ______________________
Predominio lateral:
Izquierdo
Derecho
Ambas
Sincinesas (Movimiento muscular involuntario y superfluo que acompaa a otro voluntario)
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Estereotipias (repeticin constante y automtica de movimientos o palabras)
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Destreza motora gruesa: ___________________________________________________________
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Destreza motora fina: _____________________________________________________________
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Estado psicomotriz actual: __________________________________________________

Estimulacin temprana: ____________________________________________________
Observaciones
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f. Control de esfnteres
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Iniciacin del control esfinteriano urinario: ______________________________________
Iniciacin de control esfinteriano anal: _________________________________________
Retencin o juegos con la orina y heces: _______________________________________
Frecuencia de detencin una vez aprendida la retencin: __________________________
Caractersticas generales sobre la educacin de esfnteres: ________________________

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Hbitos higinicos: ________________________________________________________
Observaciones
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g. Lenguaje
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Indicar a qu edad logr realizar las siguientes actividades:
Balbuceo: ____________________ imitacin de sonidos: ___________________
Slabas: ______________________ Primeras palabras: _____________________
Frases: _______________________oraciones completas: ___________________
Dificultades de lenguaje: ____________________________________________________
Idiomas que conoce y utiliza: ________________________________________________
Observaciones
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h. Sueo
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Cmo fue su sueo durante los primeros aos de vida? __________________________
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Llanto nocturno: SI NO Especifique: ________________________________________
Necesidad de elementos de compaa: Luz, Juguetes ____________________________
Horarios de sueo: __________________________ Siesta: ________________________
Pesadillas y sueos:_______________________________________________________
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Insomnio: ______________________________________________________________
Hipersomnio: ____________________________________________________________
Observaciones
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i.

Antecedentes mdicos

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Indicar que vacunas
Enfermedades
Edad
que
ha padecido
se han administrado
Sarampin
Sarampin
Poliomielitis
Poliomielitis
Difteria
Difteria
Tos ferina
Tos ferina
Ttano
Ttano
Rubeola
Rubeola
Paperas
Paperas
B.C.G.
B.C.G.
Tifoidea
Tifoidea
Otra:
Otra:
Trastornos psicolgicos familiares: ____________________________________________
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Trastornos psicolgicos anteriores del nio: _____________________________________
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Enuresis (miccin repentina): ____________________________________________
Encopresis (perdida voluntaria e involuntaria de heces): ___________________________
Frote ansioso o trueno de manos: _____________________________________
Chupeteo del pulgar u otros dedos: ____________________________________
Chirriar dientes: ___________________________________________________
Tics nerviosos: ____________________________________________________
Antecedentes mdicos (edad, vivencia, tratamiento, hospitalizacin, secuelas):
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Antecedentes traumatolgicos:
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Antecedentes quirrgicos:
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Trastornos perceptivos: ____________________________________________________
Desmayos: ___________________________________________________
Cefaleas: ____________________________________________________
Convulsiones: _________________________________________________
Trastornos neurolgicos: ___________________________________________________
Actitud del nio frente a la enfermedad y la muerte: ______________________________
Actitud de los padres frente a la enfermedad y la muerte: __________________________
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Observaciones

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j. Juegos
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Juegos preferidos (solo o en compaa, activos o pasivos, con nios de la misma edad, menores o mayores, gnero)
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Rol: ____________________________ Intensidad: ______________________________
Horario: _________________________ Deportes: _______________________________
Lecturas:________________________ Actividades grupales: ______________________
Observaciones
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k. rea sexual
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Tocamientos: ____________________________________________________________
Masturbacin: ____________________________________________________________
Juegos e investigaciones sexuales: ___________________________________________
Nivel de esclarecimiento sexual por parte de los padres. Edad y reacciones del nio y de
los padres _______________________________________________________________
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Desarrollo sexual: _________________________________________________________
Actitud de padres ante el tema: ______________________________________________
Educacin sexual en establecimiento escolar: ___________________________________
Observaciones
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VII. Historia familiar

Personas con las que vive el nio(a) incluyendo el nombre y calidad de la relacin
Padre:__________________________________________________________________
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Madre:__________________________________________________________________
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Abuelo paterno: ___________________________________________________________

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Abuela paterna: ___________________________________________________________
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Abuelo materno: __________________________________________________________
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Abuela materna: __________________________________________________________
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Bisabuelos: ______________________________________________________________
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Hermanos:_______________________________________________________________
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Otros:
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Reaccin ante la prdida de seres queridos:
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Reaccin ante las mudanzas: ________________________________________________
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Reaccin ante los festejos y regalos: __________________________________________
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Tiempo dedicado por los padres a la convivencia familiar: _________________________

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Conducta del nio(a) en casa: _______________________________________________
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Aplicacin de premios o castigos: _____________________________________________
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VIII. Historia escolar

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Edad y reacciones ante el inicio escolar:
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Colegio

Edad

Grados
cursados

Caractersticas especiales de algn colegio o maestros que hayan podido influir en el

nio:____________________________________________________________________
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Dificultades para el aprendizaje: ______________________________________________
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Rendimiento escolar general: ________________________________________________
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Dificultad para alguna(s) materia(s): ___________________________________________
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Actitud frente a exmenes, presentaciones y estudios en general: ___________________
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Grados repetidos: _________________________________________________________
Actitud de padres ante el rendimiento escolar: ___________________________________
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Actividades extracurriculares: ________________________________________________
Conducta escolar: _________________________________________________________

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Observaciones
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IX.

Relaciones sociales
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Preferencia de amistades: __________________________________________________
Comportamiento ante adultos: _______________________________________________
Relacin con sus compaeros de clase:________________________________________
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Relacin con sus maestros: _________________________________________________
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Preferencias de animales: __________________________________________________
Desagrado de animales: ____________________________________________________
Observaciones
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X.

Observaciones
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Nombre del entrevistador

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Firma del entrevistador

Guatemala, _________________________________de 20___

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